What I've learned about suicidal ideation

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I've posted before about this concern with DS, and we have found a way to handle it that seems to be working at the moment, so I thought I would share. I should mention at the outset: I am NOT a doctor, I do NOT know your kid, and suicide is a very real risk for kids on the spectrum - so please, please make sure you get trustworthy professional support if your child is self-harming or talking about harming him or herself.

At any rate, as I've mentioned before, DS first threatened suicide at the age of four, before he knew the words for "kill," "die" or "shoot." It has always been terribly frightening for me on two counts: one, the fear of my beloved child hurting himself, and two, remembering the same pain and distress I felt when I was his age, and wanting more than anything to make him feel better.

The suicidal language would disappear for a while and then reappear if DS had any kind of major setback. Each time, we would go running for a professional and by the time we got an appointment, he would be charming and smiling and we'd be told something along the lines of "oh, he's fine." While he never came close to actually hurting himself beyond some head-banging and poking himself with a pencil, I never felt that he was "fine;" I knew that at least his level of distress was genuine even if his words might not be.

Flash forward six years, and we're in process for the Aspergers Diagnosis (we now have a clinical diagnosis of Aspergers) DS is having a terrible year at school, and the suicidal language starts to come back...but not just at home, and not just occasionally. I get calls from concerned parents whose kids heard him talk about wishing he was dead. The language changed from "I want to kill myself" to "I'm going to get a knife and stab myself" (he's pain-averse, so that one concerned me only slightly more) to "I'm going to put a bag over my head and suffocate myself" (that one really scared me.) He started asking about household poisons.

We set up a crisis plan at school, which increased his level of distress since he wasn't allowed to be alone - but neither we nor the school wanted to take any chances. We brought the concerns to our clinician, who suggested that we go to the Children's ER immediately the next time he talked this way, to make sure we were seen in the moment while he was still upset, before he had time to put on the "I'm fine" act.

And so we did. Fortunately, we were there on a day where they had time to deal with us, and I talked a long time with the social worker. After explaining that our options were a partial hospitalization of 10 days, or admission to the ER and medication, she reminded me that Aspie kids struggle with language and meaning. We carefully discussed all my concerns, and I explained that I was concerned about the combination of this new language and DS's lack of impulse control. She said she would admit him at my direction - if I thought I couldn't keep him safe at home. She said that it sounded like DS was struggling to find words to express his level of distress, and not that he actually intended to do himself harm, and that we keep a close enough eye on him that, in her opinion, he'd be safe at home. However, she suggested that we bring him back to the ER whenever he says he is going to hurt himself: in that way, we are helping him learn the meaning of those words without punishing him for expressing himself - and if there is real danger he will be kept safe. She also said that if we wind up making repeated trips to the ER, that in itself would indicate he should be admitted to the outpatient program for closer observation, which makes complete sense to me.

After this meeting, the staff psychologist came out and asked us if DS was hiding weapons or poisons in his room (he isn't, he hides stolen candy there.) This struck me as being a vitally important thing to look for. So, finally, I felt we were taken seriously and have a reasonable plan of action without draconian consequences for overreacting, and reasonable assurances that my son will be kept safe. With this information, we decided that it was safe to take DS home.

We also got feedback from his psychologist today; she said he doesn't seem "fragile" to her, and that the suicidal language is likely a combination of a pragmatic speech problem and an emotional regulation problem - but, while the level of distress is real, she did not think DS would act on his words. She suggested that each time we wait for a few minutes to see if the language changes as he becomes calmer (it took him three hours to calm down in the episode that sent us to the ER) but that taking him to the ER was a good strategy.

I feel like 1000 pounds has been taken off my back. Even if all the people who said "he's fine" are right, with this strategy I feel much safer; I hope no one else is going through this but I thought I would post in the event that this is helpful to someone.

Your post was VERY helpful to me. I've been in a similar situation with my 9 year old son who has Aspergers. It is very scary when he expresses how unhappy he is, and it comforts me to hear you say that your son doesn't intend to hurt himself. He just has difficulty expressing the depths of his sadness.

Now I am no professional either, just want to throw in a thought here, bareing in mind a lot of suicide attempts are crys for help or attention, I hope there is no danger that your child might learn that even a mention of suicide brings a lot of interesting adult attention.

I was obssessed with death when I was young, my favourite fantasy as a six year old was of a girl I fancied crying at my grave.
No one ever took any notice of me and Iam still here.

Do be careful and check in with a professional...every situation is different. There is this overlay of language/emotion that is not uncommon, but there are still kids who are in danger.

Nambo, I think this is the case at school and with the other children - but DS did NOT like spending 4 hours sitting in the ER. While it isn't a punishment, it isn't lollipops and rainbows, either; it also gives us a matter-of-fact way to handle the situation that isn't so emotionally charged; we just bundle him in the car, and off we go.

I had a friend who attempted suicide in college - at that time, I realized that if he was willing to gamble his life to get attention, he must really, really need attention. I turned out to be right.

Be careful of the quite times as well. I have attempted suicide several times however no one around me knows. Depression in its blackest depths is a real problem for me and the only person who knows this is the psychologist who diagnosed me AS. My wife and my family have no idea of the depression or its effects. When it takes me i tend towards becoming quite and disappearing to a place where i can fall apart on my own. I think i have enough years under my belt that my death wont come at my hands but when i was a teen it was a very different story. Just be on guard if he ever starts going quite and disappearing for a time.

momsparky, sorry you are dealing with this. My daughter also states she wants to die often. It distresses me greatly, however, it usually passes with time and she once again finds a reason to be happy. I think with my daughter it definitely is real, even if it is a severe proclamation, she definitely knows what it means. I think most people in society "know" that it's "wrong" to say you want to die and so they don't say things like that (even if they might fleetingly think it). My daughter doesn't have the filter or the desire to filter. Plus, I do think she is more depressed than most due to the social skills deficits and her ritualistic behaviors. It's great that you've found a plan that makes you feel better. I've thought as my daughter is getting older that I will have to secure all dangerous substances/items. I worry about how we will deal with this.

It has been really scary, but having a clear plan has been very, very helpful. What scared me most was that we've been hearing it for 6 years now - and I was afraid I would habituate to the fear and miss or ignore a time when it was more serious; it's comforting to be able to put the assessment in the hands of a professional.

I also think we have found interventions that will actually help, and am hoping this will lessen the depression over the coming year.

While I'm glad I'm not alone in this, I sort of wish I was...I offer all of you virtual hugs.

I think the clinician you're dealing with is likely spot-on in the assessment of your son's suicide language being more about wanting the situation to stop, not life. For a child, life can feel so overwhelming, and especially a kid on the spectrum. I had immense difficulty expressing myself as a child, and I often spoke the same way. I never made plans or really wanted to harm myself, but I did think about suicide and dying and I did talk about it when things felt insurmountable. It was terrifying to my parents, of course, but it was my way of screaming, "I CANNOT TAKE THIS - IT HAS TO STOP."

Still, be aware of the very real possibility that these suicidal thoughts can turn into attempts if things escalate to a point that is purely intolerable...and the signs may not be readily apparent. Keep the lines of communication open with your son, and encourage him to discuss his feelings with someone safe - even if it isn't you.

My 12yr old son talks about wanting to die constantly he has a diganosis for adhd, odd and waiting for confirmation for AS I take him to the local clinic whom are disputing his adhd diganosis and his AS they try to reassure me he doesnt mean it and that he is not going to take his life. I have been told to take him to ER or arrange an appointment if I am concerned I am concerned all the time dont know what to do he repeats this numerous times each day I realise the problem is school but the school have not picked up on anything and when I go and speak to them they think I am over reacting. When I get the report and confirmation of AS I will speak with them I will not be sending my son back to school until there is a plan in place and an understanding of his needs. I have been fighting with this for so long my heart sinks everytime he mentions the word die I feel so helpless I keep him with me know all the time. I dont just feel your pain I know it good luck and I hope your plan of action helps I am still waiting for the so called pro's to wake up and listen.

Thank you for this post--I found it at a time when I desperately needed to read it. My son and I both have AS. He is almost 12 and his aggression has become stronger in the last several months or so. I am attributing this to the surge of testosterone which occurs in adolescent boys.

However, in the past few months or so, he has several times mentioned wanting to hurt or kill himself. This is very disturbing to me and to his teachers and classmates. Though I have been to the depths of depression myself and have twice been hospitalized because of it and accompanying suicide attempts/idealizations, my son's words have disturbed me greatly. I think he needs to find more suitable ways of verbalizing his frustrations other than talking of harming himself.

What scares me is that I don't want him to actually attempt or succeed in an attempt--it would destroy me to lose him. I put a call into his doctor today because of these concerns and I'm awaiting her call.

When I was younger, I used to day-dream of suicide and imagine how much attention it would bring me, filling me with a sense of purpose. It was quite exhilarating.

I would personally provide reasons to love and cherish his life to him without expressing it solely in words. Introduce him to a variety of healthy hobbies and interests until he picks up on one he finds a passion for. Expression is a cure for depression.

Just my opinion though.